Does Atrial Septal Anatomy Still Matter in the Etiological Evaluation of Ischemic Stroke Beyond the Age of 60?

BACKGROUND

Patent foramen ovale (PFO) is causally associated with stroke in some patients younger than 60 years, especially when it is large or associated with an atrial septal aneurysm (ASA). After 60 years of age, this association is less well understood. We assessed the relationships between detailed atrial septal anatomy and the cryptogenic nature of stroke in this population.

METHODS AND RESULTS

We reviewed all patients aged 60 to 80 years admitted to our stroke center for ischemic stroke who underwent contrast echocardiography between 2016 and 2021. The atherosclerosis, small-vessel disease, cardiac pathology, other causes, and dissection (ASCOD) classification was used to reevaluate the etiological workup. Associations between cryptogenic stroke and (1) PFO presence or (2) categories of PFO anatomy (nonlarge PFO without ASA, nonlarge PFO with ASA, large PFO without ASA, and large PFO with ASA) were assessed using logistic regression. Among 533 patients (median National Institutes of Health Stroke Scale score=1), PFO was present in 152 (prevalence, 28.5% [95% CI, 24.9-32.5]). Compared with noncryptogenic stroke, cryptogenic stroke (n=218) was associated with PFO presence (44.5% versus 17.5%; P<0.0001). Among patients with a PFO, septal anatomy categories were associated with cryptogenic stroke (P=0.02), with a strong association for patients with both large PFO and ASA (38.1% versus 14.5%, P=0.002).

CONCLUSIONS

PFO presence remains strongly associated with cryptogenic stroke between 60 and 80 years of age. Large PFO, ASA, and their association were strongly associated with cryptogenic stroke in this age group. Our results support performing contrast echocardiography even after 60 years of age, although the optimal secondary prevention therapy in this population remains to be determined in randomized trials.

[Ambulatory Electrocardiogram In Stroke Patients At The University Hospital Of Brazzaville: 81 Cases]

OBJECTIVE

To assess the value of Holter ECG in the assessment of patients experiencing ischemic stroke.

PATIENTS AND METHODS

This was a prospective descriptive study conducted in the Department of Neurology of the University Hospital Center in Brazzaville between June 2011 and June 2012.

RESULTS

There were 53 men (63.9%) and 30 women (36.1%), mean age 60.6 ± 12.7 years (range = 20 to 85 years). The average body mass index was of 26.9 ± 4.6 (range = 15.6 and 35.3). Patients were obese in 19 cases (22.8%), overweight in 16 cases (19.2%). Hypertension was found in 44 patients (53%), diabetes mellitus in 14 patients (16.8%), dyslipidemia, smoking, respectively, six (7.2%) and one case. The Holter ECG performed in 81 patients showed: sinus rhythm in 78 cases (96.3%), an average frequency of 79.1 ± 17.6 beats per minute (range = 50 to 163 years), atrial fibrillation in seven cases (8.6%), one case of atrial flutter, supraventricular tachycardia bursts in 14 cases (17.2%), supraventricular extrasystoles in 78 cases (96.3%), 65 cases (80.2%) with doublets and 27 cases (33.3%) with triplets. In 35 cases, there were more than 70 supraventricular extrasystoles per 24 hours. Ventricular extrasystoles were present in 59 cases (72.8%), including 24 cases of doublets (29.6%), 14 cases (17.2%) of bigeminy and three cases of nonsustained ventricular tachycardia. Breaks were significant in both cases. The study of HRV showed a 100.4 ± 45.8 to SDNN ms (range = 20 to 206 ms), 44 patients (54.3%) had impaired heart rate variability in 44 (54.3%).

CONCLUSION

The ischemic stroke is a serious life-threatening and functional. Administering a Holter ECG is essential to find a cardioembolic cause, allowing for the most appropriate treatment.